Article Text

Download PDFPDF
Against lifetime QALY prioritarianism
  1. Anders Herlitz1,2
  1. 1 Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
  2. 2 Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
  1. Correspondence to Dr Anders Herlitz, Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg SE-405 30, Sweden; andersherlitz{at}


Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that a health state at some period in time contributes with the same amount to how well off someone is regardless of intrapersonal and interpersonal distributions of health states. The paper argues that this is implausible and that prioritarians should take both intrapersonal and interpersonal distributions of goods into account when they establish who is worse off. They should therefore not accept that lifetime QALY is a reasonable ground for ascribing priority and reject lifetime QALY prioritarianism.

  • allocation of health care resources
  • political philosophy
  • health economics
  • health care economics
  • distributive justice

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The work has been supported by Forte, The Swedish Council for Health, Working Life and Welfare, grant number 2014-2724.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. Table citations and headings have been added.

Other content recommended for you